糖尿病酮症酸中毒患者脑脊液酸碱失衡及其代偿机制  

Study of CSF acid-base disorders and compensatory mechanism in patients with diabetic ketoacidosis

作　　者：金发光[1] 钱桂生[2] 赵自强[2] 刘同刚[1] 党永进 

机构地区：[1]第四军医大学唐都医院呼吸内科 [2]第三军医大学新桥医院呼吸病研究所 [3]解放军68351部队门诊

出　　处：《第四军医大学学报》2003年第6期567-569,共3页Journal of the Fourth Military Medical University

摘　　要：目的 :探讨糖尿病酮症酸中毒患者脑脊液 (CSF)酸碱变化及其代偿机制 .方法 :采集分析 15例糖尿病酮症酸中毒患者动脉血和CSF酸碱变量 .结果 :①CSFpH ,PCO2 ,HCO3-均低于正常对照值 (P <0 .0 1) ,同血液一样发生代谢性酸中毒 ;②CSFpH ,PCO2 ,HCO3-较动脉血高 (P <0 .0 1) ,而且相互之间呈显著正相关 ;③CSF酮体较正常对照值高 (P <0 .0 1) ,较动脉血低 (P <0 .0 1) ,且同动脉血酮体显著正相关 ;④CSFHCO3-同CSFPCO2 显著正相关 ,同CSF酮体显著负相关 ;⑤CSFpH同CSFHCO3-显著正相关 ,同CSF酮体显著负相关 .结论 :糖尿病酮症酸中毒时 ,CSF同动脉血一样发生代谢性酸中毒 ,但由于血 脑、血 CSF屏障有抑制血酮体进入CSF的作用及CSFPCO2 相对较高的代偿 ,CSFpH能相对维持在一个接近正常的范围 .如果血酮体明显升高 ,PaCO2 大幅度下降 。AIM: To investigate cerebrospinal fluid (CSF) acid base disorders and its compensatory mechanism in patients with diabetic ketoacidosis. METHODS: Arterial blood and CSF samples from 15 patients with diabetic ketoacidosis were collected and analyzed. RESULTS: ① Although metabolic acidosis occurred in CSF as in arterial blood, CSF pH, PCO 2 and HCO 3- were lower than those in the control (P<0.01); ② CSF pH, PCO 2, HCO 3- were higher than those in the arterial blood in patients with ketoacidosis (P<0.01) and there was a significant positive correlation between CSF and the arterial blood; ③ Ketone bodies of CSF were higher than those in the control (P<0 01) but were lower than those in the arterial blood (P<0 01) and there was a significant positive correlation between CSF and the arterial blood; ④ There was a significant positive correlation between CSF HCO 3- and CSF PCO 2 but there was a negative correlation between CSF HCO 3- and CSF ketone bodies; ⑤ There was a significant positive correlation between CSFpH and CSF HCO 3- but there was an negative correlation between CSF pH and CSF ketone bodies. CONCLUSION: Although metabolic acidosis occurred in CSF as in arterial blood, the normal range of CSF pH can be maintained for the reason that the barrier of blood brain and blood CSF inhibits blood ketone bodies from entering CSF and the compensation ability of CSF PCO 2 is higher than that of arterial blood. In case blood ketone bodies increase markedly, PaCO 2 will decrease significantly, thus leading to sever metabolic acidosis in CSF.

关 键 词：糖尿病酮症酸中毒 脑脊髓液 酸碱失调 代偿机制 

分 类 号：R589.6[医药卫生—内分泌] R587.2[医药卫生—内科学]